Health and Social Care Update

Rosie Winterton Excerpts

Thursday 22nd September 2022 Commons Chamber

[The Secretary of State for Health and Social Care (Dr Thérèse Coffey)]

I am pleased today to set out to Parliament our plan for patients. As the Prime Minister said on the doorstep of Downing Street, she had three clear priorities: growing the economy; tackling energy security and support for households and businesses; and the NHS, with patients being able to get a GP appointment.

Patients are my top priority and I will be their champion, focusing on the issues that most affect them or their loved ones. Most of the time, patients have a great experience, but we must not paper over the problems that we face. We expect backlogs to rise before they fall as more patients come forward for diagnosis and treatment after the pandemic, and the data shows, sadly, that there is too much variation in the access and care that people receive across the country.

The scale of the challenge necessitates a national endeavour. As we work together to tackle these immense challenges, I will be proactive, not prescriptive, in our approach as we apply a relentless focus on measures that affect most people’s experience of the NHS and social care.

Today, we are taking the first step in this important journey by publishing “Our Plan for Patients”, which I will lay in the Libraries of both Houses. It sets out a range of measures to help the NHS and social care perform at their best for patients. The plan will inform patients and empower them to live healthier lives; place an intensive focus on primary care, the gateway to the NHS for most people; use prevention to strengthen resilience and the health of the nation; and improve performance and productivity.

To succeed, we will need a true national endeavour, supported by our making it easier for clinical professionals to return to help the NHS, as well as drawing on the energy and enthusiasm of the million people who volunteered to help during the pandemic by opening up opportunities for them to help in different ways. That could be by becoming a community first responder, or by, for example, strengthening good neighbour schemes across the country. We will also explore the creation of an ambulance auxiliary service.

The plan sets out our work on the ABCD of priorities that affect most people’s experience of the NHS and social care. First, on ambulances, I want to reduce waiting times for patients and apply a laser-like focus on handover delays, so that ambulances get back on the road and to patients, where they are needed most.

Our analysis shows that 45% of the delays are occurring in just 15 hospital trusts. That is why the local NHS will be doing intensive work with those trusts to create more capacity in hospitals—the equivalent of 7,000 more beds—by this winter through a combination of freeing up beds, with a focus on discharge, and people staying at home and being monitored remotely through the sort of technology that played such an important role during the pandemic. In addition, when patients call 999, the speed of answering is critical, so we will increase the number of call handlers for both 999 and 111 calls.

Next is the backlog, where the waiting list for planned care currently stands at about 7 million, exacerbated by the pandemic. This summer, we announced that we have virtually eliminated waits of over two years, and we remain on track to reach the next milestones in our plan. To boost capacity, we are accelerating our plans to roll out community diagnostic centres as well as new hospitals, and we will maximise the use of the independent sector to provide even more treatment for patients.

As well as capacity, we are also getting more people on the frontline, making it easier for people to work in and help the NHS. We know that people are leaving the workforce for a variety of reasons. We have listened, and we are responding and addressing a number of those reasons. For instance, pension rules can currently be a disincentive for clinicians who want to stay in the profession or to return from retirement and help our national endeavour. We will correct pension rules relating to inflation; we will expect NHS trusts to offer pension recycling; and we will extend until 2024 measures that will allow people to stay or return to the NHS.

I can announce today that we will extend the operation of the emergency registers for health professionals for two more years. That is, of course, on top of commitments to boost the health and care workforce, such as our manifesto pledge to recruit 50,000 more nurses by 2024. That will sit alongside the design and delivery of our forthcoming workforce plan.

C is for social care. At the moment, one of the key challenges is discharging patients from hospital into more appropriate care settings to free up beds and help improve ambulance response times. To tackle that, I can announce today that we are launching a £500 million adult social care discharge fund for this winter. The local NHS will be working with councils with targeted plans on specific care packages to support people being either in their own home or in the wider community. That £500 million acts as the down-payment in the rebalancing of funding across health and social care as we develop our longer-term plans.

I know that there is a shortage of carers across the country. We will continue to work with the Department for Work and Pensions on a national recruitment campaign. In addition, since last winter, we have opened up international recruitment routes for carers. We will support the sector with £15 million this year to help to employ more care workers from abroad. We are also accelerating the roll-out of technologies such as digitised social care records, which can save care workers about 20 minutes a shift, freeing up time for carers to care.

Finally, D is for doctors and dentists. I am determined to address one of the most frustrating problems faced by many patients: getting an appointment to see their doctor, or getting to see a dentist at all.

Starting with doctors, we are taking five steps to help make that happen: first, setting the expectation that everyone who needs a GP appointment can get one within two weeks; secondly, opening up time for more than 1 million extra appointments, so that patients with urgent needs can be seen on the same day; thirdly, making it easier to book an appointment; fourthly, publishing performance by practice to help to inform patients; and fifthly, requiring the local NHS to hold practices to account, providing support to those practices with the most acute access challenges to improve performance.

Clearly, clinicians are best placed to prioritise according to the clinical need of their patients. In July, 44% of appointments were same-day appointments, but too few practices were consistently offering appointments within a fortnight.

To help free up appointments, we will ease pressures on GP practices by expanding the role of community pharmacies. I am pleased to announce that we have agreed a deal for an expanded offer over the next 18 months. Pharmacists will be able to prescribe certain medications rather than requiring a GP prescription. As well as other measures involving community pharmacists, we estimate that that will free up 2 million appointments. We are also changing funding rules to give freedoms to GPs to boost the number of staff to support their practice. We estimate that that measure could free up 1 million GP appointments.

For patients, we will make it easier for them to contact their practice, both on the phone—we are making an extra 31,000 phone lines available this winter, followed by further deployment of cloud-based telephony—and online, particularly through the NHS app. As I set out, we will also correct pension rules so that our most experienced GPs can stay in practice. By extending the emergency register, we are creating opportunities for people other than GPs to undertake tasks such as vaccinations.

On dentists, there are too many dental deserts. That is why we are setting out an ambition that everyone seeking NHS dental care can receive it when they need it. We have already started changing the dental contract to incentivise dentists to do more NHS work and take on more difficult cases. I pay tribute to my predecessors in this role for their success in beginning to tackle this long-standing issue.

We will also streamline routes into NHS dentistry for those trained overseas so that they can start treating patients more quickly. We will make it a contractual requirement for dentists to publish online whether they are taking on new NHS patients.

These measures, across a number of important areas, are the start, not the end, of our ambitions for health and care. They will help us to manage the pressure that health and care will face this winter and next, and they will improve these vital services for the long term. My priorities are patients’ priorities, and I will endeavour, through a powerful partnership with the NHS and local authorities, to level up care and match the expectations that the public rightly have. Whether you live in a city or a town, in the countryside or on the coast, this Government will be on your side when you need care the most. I commend this statement to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State.

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[Dr Coffey]

I thank the hon. Gentleman for his warm welcome to my ministerial team and me. It has been just two weeks—[Hon. Members: “Twelve years!”] Forgive me. Well, in those12 years there have been more doctors and nurses working in the NHS than ever before. We have record funding going into the NHS. The money that the Government spend through the Department of Health and Social Care is about 40% of our day-to-day spending. That is the reality of the Conservative party investing in the long-term health of our nation.

The hon. Gentleman mentioned a variety of things. I can absolutely say that there will be no changes to the target of a four-hour wait in A&E. I believe that it matters. I will give the House a recent personal experience. In July, I went to A&E myself; I waited for nearly nine hours to see a doctor, and I still did not get any treatment. I was asked to go back the next day, so I went to a different hospital just three miles away and was seen and treated appropriately. That is the sort of variation we are seeing across the NHS, and it is the reason for my approach.

Only last week we started getting some data from NHS Digital about what is happening practice by practice, so we can start to understand it and start to use experts in the local NHS to prioritise helping those patients who are not getting the service that they should rightly expect, while giving freedom to those other GPs who are doing a fantastic job of supporting patients in their practice. That is why I do not intend to be prescriptive, but I am determined on behalf of patients to drive up the performance of those who need help to do things better.

On ambulances, I am very conscious of the issue. The hon. Gentleman is right to say that we have been in power for 12 years, and I am conscious that I have been working for a decade on improving things for my constituents as well. With a particular focus on ambulances, I think it would be helpful for the House to learn about our recent analysis showing that 45% of the handover delays are concentrated in a part of the country. Even so, I appreciate that that is not good enough.

I also understand that although similar numbers of ambulance calls are being made, there are many more category 1 and 2 calls and our fantastic paramedics are treating more people at home without needing to take them to hospital. Nevertheless, that brings me the challenge of how we can do more to help ambulances get back on the road so that they can treat patients. As with many other emergency services, we also need to consider the potential extension of volunteers through auxiliary services or community first responders. In London alone there are about 120 community first responders, but I think I have more than that in my constituency of Suffolk Coastal. It is about recognising that for the million people who volunteered to help, we can find a way for them to help us during these particularly challenging times, as well as working with the NHS to tackle the fundamental issues.

On access to GPs, I am conscious that Labour introduced the 48-hour target when it was in power. We were told by the NHS and by doctors that of course they met it—I expect that was part of their contracts—but that it did not necessarily mean better outcomes for patients at their practice; indeed, they got into a routine of not booking appointments more regularly. It is important that we address that.

I am very conscious that the plan for patients has only just been published. I deliberately tried to ensure that we held back important aspects of it, such as the £500 million adult discharge fund, for the House’s interest rather than speaking about them before coming here today.

I can assure the hon. Gentleman that I am very happy to continue to work in partnership with the NHS. Keeping the focus on patients is critical, as is building on the existing NHS winter plan, developing the workforce, and all the plans and strategies that need to be carefully considered as we set about the long-term improvements that I think he will enjoy and will want me to champion on behalf of patients.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

I welcome the Secretary of State to her new role. As I know, it is the hardest job in Government, but she has a zen-like calmness which means that she is well suited to dealing with the pressures that lie ahead.

There is much to be welcomed today, particularly the pension rule changes, the additional funds for social care and the new powers for pharmacists, but may I ask the Secretary of State to rethink the new two-week access target for general practice? If targets were the answer, we would have the best access in the world in the NHS, because we have more targets than any other healthcare system in the world. GPs alone have 72 targets, and adding a 73rd will not help them or their patients, because it is not more targets but more doctors that the NHS needs. Will the workforce plan to which the Secretary of State recommitted herself—I welcome her commitment to publishing it—include hard numbers, so we can know how many doctors we will need in 10, 15 and 20 years’ time and whether we are actually training them, and will she publish it before Christmas so that staff can at least go into the winter knowing that there is a plan for the future?

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[Dr Coffey]

I thank my right hon. Friend. I remember supporting him from the Back Benches in his passion for the NHS, and I am absolutely committed to continuing that.

I think my predecessors may have committed themselves to publishing aspects of, or conclusions from, the workforce plan, but I assure my right hon. Friend that now that I have spent time focusing on the priorities, work on the plan is already ongoing and I hope to make progress on further elements today, working alongside my new ministerial team, so that we can maximise that progress.

One of the key things that I want to do is make it more straightforward for people—wherever they are in the world, as long as they are of sufficient quality—to be able to come and practise in England. I was astonished to learn that we cannot even allow people who are accredited in Scotland to come here straight away and practise as dentists. We will be laying regulations on the day we return from the recess, which will enable the General Dental Council, for example, to accelerate this aspect of streamlining so we can ensure that when high-quality doctors and dentists are accredited, anywhere in the world, we can take that into account and enable them to help patients in this country more rapidly.

[Madam Deputy Speaker]

I call the Scottish National party spokesman, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Let me start by welcoming the Secretary of State to her new role and thanking her for advance sight of her statement.

There is no doubt that the NHS, in all four nations, is facing an incredibly difficult winter, with possible rises in covid infections alongside winter illnesses and increases in slips and falls, all of it while recovering from the dire effects of the pandemic and, now, an energy crisis. An inflation-busting uplift is vital to getting our health systems back into good shape, enabling them to get through this winter and support those in need. It has been estimated that the cost of living crisis will add £3.7 billion a year to the cost of social care alone, with far higher rises across the NHS generally. How does the Secretary of State justify her Government’s prioritising of bankers and tax cuts for the rich at a time when investment in public services is more essential than ever, and will she support the SNP’s call for an NHS uplift greater than inflation?

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Obviously, many colleagues want to contribute, but if we are going to get everybody in, that will require brevity. I call Steve Brine.

[Steve Brine (Winchester) (Con)]

Thank you, Madam Deputy Speaker. I warmly welcome the Secretary of State to her role and wish her all the best. Her predecessor talked about a new cancer agenda. Could she indicate whether that is in the offing, and will it be accompanied by a genuine cancer workforce plan? Will it involve what my hon. Friend the Member for Erewash (Maggie Throup), the former public health Minister, rightly mentioned about prevention in respect of obesity, the second biggest cause of cancer in this country, and, obviously, smoking, the biggest preventable cause of death in this country?

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[Dr Coffey]

I decided to diagnose, in effect, what is happening care by care, and that is really important. Nevertheless, more generally, I will of course be introducing the £500 million care fund to make sure that that happens.

[Madam Deputy Speaker (Dame Rosie Winterton)]

It may be helpful if I explain that I am trying to call people first in this statement who perhaps did not get in during the last statement.